Current trends in treatment outcomes of orbital cellulitis in a tertiary hospital in Southern Nigeria

Background: Orbital cellulitis refers to the inflammation or infection of the soft tissues of the orbit located behind the orbital septum. Aim: To determine the current trends in the outcomes following the management of orbital cellulitis in a tertiary hospital in Southern Nigeria. Patients and Methods: A retrospective review of medical records of patients with orbital cellulitis from January 2008 to December 2014 was conducted. The age, sex, duration of symptoms, predisposing factors, clinical findings,  laboratory/radiological investigations, treatment provided, complications, and follow‑up were recorded. Results were analyzed with SPSS Version 21 program. Results: Forty‑two patients were seen made of 17 (40.5%) males and 25 (59.5%) females with a mean age of 18.2 ± 18.7 years of which children <16 years constituted 24 (57.1%) of cases. Orbital cellulitis was a unilateral occurrence in 38 (90.5%) patients. Trauma and sinusitis were the common predisposing causes in 20 (47.6%) and 6 (14.3%) patients, respectively. The most common complaint was eye swelling 36 (52.9%). Most patients had visual acuities of >6/18 at  presentation, 38 (82.6%) and at discharge, 39 (84.8%). The mean duration of presenting complaints was 15.5 ± 31.6 days. Patients who presented early were less likely to develop complications, P = 0.003. The most common complication was exposure keratopathy in 8 (44.4%) eyes. The only surgical intervention performed was incision and drainage of abscess in 3 (7.1%) eyes. No patient came for follow‑up. Conclusion: Prompt institution of effective antibiotics and management of  complications that may arise improves prognosis of orbital cellulitis.Keywords: Antibiotics, orbital cellulitis, Southern Nigeri

Cataract Surgical Outreach in a Tertiary Hospital in Nigeria: An Appraisal

Background: Cataract remains the main cause of reversible blindness in Nigeria. However, access to cataract surgery has been hampered by lack of funds and a dearth of eye care professionals. Surgical outreaches have been used as one of the tools to reduce the cataract backlog. Aim: To review a free cataract surgical outreach in a tertiary hospital funded by the Federal Government of Nigeria. Subjects and Methods: A three-day free cataract surgical outreach at the directive of the President of the Federal Republic of Nigeria, President Goodluck Jonathan was organised at the University of Benin Teaching Hospital (UBTH), Benin City. The records of all patients who had cataract surgery during the program were retrieved. The demographics, ocular assessment, surgical notes, post-operative and follow-up data were extracted and collated. Data was analysed using Microsoft Excel 2007(Microsoft Corporation Inc, Washington, USA). Results: A total of 209 patients had cataract surgery made of 134/209(64.1%) males and 75/209(35.9%) females. The mean age of the patients was 61.8(14.5) years (range 20 to 89 years). The majority of the patients, 137/209(65.6%) were ≥ 60 years and 145/209(69.4%) of the beneficiaries were low income earners. A total of 130/209(62.2%) patients had never been seen by an eye care specialist. Conclusion: There is a great need to improve access to eye care services in general and cataract surgical services specifically.Keywords: Cataract blindness, Cataract surgery, Surgical outreac

Strengthening retinopathy of prematurity screening and treatment services in Nigeria: a case study of activities, challenges and outcomes 2017-2020.

OBJECTIVES: Retinopathy of prematurity (ROP) will become a major cause of blindness in Nigerian children unless screening and treatment services expand. This article aims to describe the collaborative activities undertaken to improve services for ROP between 2017 and 2020 as well as the outcome of these activities in Nigeria. DESIGN: Descriptive case study. SETTING: Neonatal intensive care units in Nigeria. PARTICIPANTS: Staff providing services for ROP, and 723 preterm infants screened for ROP who fulfilled screening criteria (gestational age <34 weeks or birth weight ≤2000 g, or sickness criteria). METHODS AND ANALYSIS: A WhatsApp group was initiated for Nigerian ophthalmologists and neonatologists in 2018. Members participated in a range of capacity-building, national and international collaborative activities between 2017 and 2018. A national protocol for ROP was developed for Nigeria and adopted in 2018; 1 year screening outcome data were collected and analysed. In 2019, an esurvey was used to collect service data from WhatsApp group members for 2017-2018 and to assess challenges in service provision. RESULTS: In 2017 only six of the 84 public neonatal units in Nigeria provided ROP services; this number had increased to 20 by 2018. Of the 723 babies screened in 10 units over a year, 127 (17.6%) developed any ROP; and 29 (22.8%) developed type 1 ROP. Only 13 (44.8%) babies were treated, most by intravitreal bevacizumab. The screening criteria were revised in 2020. Challenges included lack of equipment to regulate oxygen and to document and treat ROP, and lack of data systems. CONCLUSION: ROP screening coverage and quality improved after national and international collaborative efforts. To scale up and improve services, equipment for neonatal care and ROP treatment is urgently needed, as well as systems to monitor data. Ongoing advocacy is also essential

Indications and treatment outcomes of intravitreal bevacizumab and ranibizumab for retinal diseases in Benin City, Nigeria

Background: The emergence of intravitreal antivascular endothelial growth factors (antiVEGF) has revolutionalised the treatment and prognosis of many retinal diseases.Aim: To determine the indications and treatment outcomes for use of intravitreal antiVEGF agents in retinal diseases among patients in a tertiary hospital in Benin City, Nigeria.Materials and Methods: The case folders of patients, who had intravitreal injections of antiVEGF from January 2012 to December 2014, were analysed. Data retrieved included age, sex, indication, type of intravitreal antiVEGF used, number of injections, visual acuity, treatment outcomes, complications and follow-up duration.Results: There were 27 patients, consisting of 12 males and 14 females, with a mean age of 61.8 ± 7.8 (range 46–76) years. Intravitreal antiVEGF were administered in both eyes of 14 (51.9%) patients. Bevacizumab and ranibizumab were utilised in 36 (87.8%) and 3 (7.3%) eyes, respectively. Two (4.9%) eyes had both bevacizumab and ranibizumab during treatment switching from ranibizumab to bevacizumab. A total of 72 injections were administered during the study period with a mean number of 2.4 ± 1.5 (range 1–8) injections administered per eye. The most common indication was diabetic macular oedema in 17 (40.5%) eyes. After treatment, vision improved in 21 (51.2%) eyes and was unchanged in 10 (24.4%) eyes. Eyes, which initially improved, worsened in 10 (24.4%) patients following cessation of treatment. The most common complication encountered was subconjunctival haemorrhage in 15 (36.6%) eyes. The mean duration of follow-up was 12.4 ± 6.8 (range 4–26) months.Conclusion: Intravitreal antiVEGF are effective in the management of a vast array of retinal conditions. However, the burden of care including costs and the need for multiple injections are still drawbacks that require an alternative treatment strategy.Keywords: Aflibercept, bevacizumab, intravitreal antiVEGF, ranibizuma

Retinal vein occlusion in Benin City, Nigeria

Background: Retinal vein occlusion (RVO) is the most common occlusive retinal vascular disorder and results in varying degrees of visual loss. Aim: To determine the pattern of presentation, risk factors, and treatment outcomes in a group of patients with RVO seen in a tertiary hospital in Nigeria. Materials and Methods: Medical records of patients who presented to the University of Benin Teaching Hospital, Benin City, Nigeria in whom a diagnosis of RVO was made over a 5 years period were reviewed. Data obtained were analyzed with the GraphPad Instat Software, Inc. version V2.05a program, San Diego, Califonia and a P &lt; 0.05 considered significant. Results: There were 20 patients made of 14 (70.0%) males and 6 (30.0%) females with a mean age of 62.7 ± 10.4 years. There were 15 (68.2%) eyes with central RVO, 3 (13.6%) eyes with branch RVO, and 4 (18.2%) eyes with hemi RVO. Bilateral involvement occurred in 2 (10.0%) patients. Risk factors included hypertension 14 (70.0%), diabetes mellitus 9 (45.0%), and glaucoma 5 (22.7%). Multiple risk factors were present in 14 (70.0%) patients. Complications included macula edema 15 (68.2%), retinal neovascularization 5 (22.7%), neovascular glaucoma 3 (13.6%), and vitreous hemorrhage 2 (9.1%). Eyes which had definitive treatment with intravitreal antivascular endothelial growth factors and laser photocoagulation for macula edema and retinal neovascularization, respectively, had better visual acuity compared to eyes which did not receive these treatment, P = 0.002. Conclusion: The incidence and visual loss that occurs from RVO can be reduced by modifying known risk factors and early institution of appropriate therapy for complications that occur.Keywords: Intravitreal antivascular endothelial growth factors, laser photocoagulation, retinal vein occlusio

Traumatic hyphema in Benin City, Nigeria

Background: Hyphaema is a common sequalae following trauma. Th aim of this study was to determine the demographics, pattern, complications and visual outcome in patients managed with traumatic hyphema. Materials and Methods: A retrospective review of all cases of traumatic hyphema seen from July 1, 2008 to June 30, 2013. Data analyzed included biodata, duration of injury prior to presentation, grading of hyphema and activity during injury, visual acuity, intraocular pressure, associated injuries and complications. Results: A total of 45 eyes in 45 patients with traumatic hyphema were reviewed. The mean age of the patients was 27.3 ± 18.6 years with 44.4% occurring in the age group 0-20 years. The male:female ratio was 6.5:1. About 40.0% of patients presented within 24 h of the injury and 51.1% with Grade 1 hyphema. Injury occurred mostly during play and at work in 17.8% each. The initial visual acuity was worse than 6/60 in 82.0% but decreased to 60.0% following treatment while visual acuity of 6/18 or better increased from 6.7% at initial presentation to 31.1% following treatment. Lid and corneal injuries were the most common associated injuries in 20.0% each, while secondary glaucoma was the most common complication of hyphema in 22.2%. Conclusion: Traumatic hyphema is a common occurrence in children and young adults during play and at work. Early presentation, associated injuries, complications and management affects visual outcome

Endophthalmitis in a tertiary center in Nigeria

Background: Endophthalmitis is a sight-threatening condition due to inflammation of intraocular structures usually from infectious organisms. The study aims to identify the pattern of presentation of endophthalmitis in a tertiary center in Nigeria. Materials and Methods: A retrospective observational study of cases with a diagnosis of endophthalmitis. Results: Twenty-six eyes of 26 patients were found comprising, 20 (76.9%) males and 6 (23.1%) females. The mean age of the patients was 32.4 ± 24.5 years (range 2-68 years) of which 11 (42.3%) were ≤ 16 years (P < 0.005). There were 14 (53.8%) right eyes and 12 (46.2%) left eyes involved. The most common etiology was post traumatic infection in 16 (61.5%) cases of which 11 (68.8%) occurred in children ≤ 16 years. Complications of cataract surgery was the only surgically related etiology in 7 (26.9) cases. Endogenous endophthalmitis is a rare occurrence. Conclusion: Supervised play in children, strict adherence to asepsis protocol in surgeries, prompt diagnosis with well-equipped ancillary investigations and appropriate early intervention will help limit the incidence of endophthalmitis and improve outcomes

A Comparison Study of Conjunctiva Disorders in Technical and Administrative Sawmill Workers in Nigeria

Background: Workers in the sawmilling industry are at risk of various ocular hazards as a direct result of the sawmilling processes. The aim of this study was to determine the pattern of conjunctival disorders between technical and administrative sawmill workers in Benin, Nigeria. Methods: A cross-sectional study was performed on sawmill workers in Benin, Nigeria, between January and May 2009, with the aid of pre-tested questionnaires. Ocular examination was performed on all subjects. Data obtained were recorded and analysed using SPSS version 13. Results: A total of 553 sawmill workers were studied, among whom 449 (81.2%) and 104 (18.8%) were technical and administrative workers, respectively. There were 496 (89.7%) males and 57 (10.3%) females. The age range was 15–80 years, with a mean of 38.9 years (SD 12.8). Pingueculum was found in 127 (23%) workers, among whom 122 (27.2%) were technical workers and 5 (4.8%) were administrative workers. Pterygium was present in 65 (11.8%) workers, among whom 64 (14.3%) were technical workers and 1 (1%) was an administrative worker. Seven (1.6%) technical workers used protective eyewear; 2 (0.4%) wore this protective eyewear regularly. Conclusion: Technical sawmill workers are at risk of developing conjunctival disorders, which result from chronic ocular irritation. This can be prevented by the provision of protective eye devices in the workplace